Comparing survival rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts: A systematic review and meta-analyses

STATEMENT OF PROBLEM

When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the literature is inconclusive on the long-term clinical performance of available post systems.

PURPOSE

The purpose of this systematic review and meta-analysis was to analyze the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts.

MATERIAL AND METHODS

The research question was formulated by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the Population, Intervention, Comparison, Outcome, Study Type (PICOS) tool. Medline (PubMed), Embase, and Scopus searches complemented by manual search were performed for randomized controlled clinical trials with a follow-up of at least 2 years. Two independent authors performed screening and data extraction of the articles. Meta-analyses were performed with the RevMan software program. Homogeneity was checked by using chi2 and I2 tests, and random-effects meta-analyses were applied. Odds ratio and 95% confidence interval were calculated (α=.05). The publication bias was evaluated by using funnel plots and the Begg and Egger tests.

RESULTS

A total of 184 studies were retrieved through the electronic searches, and an additional 4 through the hand search. After title- and abstract-level exclusion, 23 studies remained for full-text analyses, of which 7 were selected for data extraction. Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.

CONCLUSIONS

No statistically significant differences were found between the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts. The overall survival rate was 92.8% for glass fiber posts and 78.1% for metal posts. Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.

Effects of scanning technique on in vitro performance of CAD/CAM-fabricated fiber posts

This study assessed push-out strength, cement layer thickness, and interfacial nanoleakage of luted fiber posts fabricated with computer-aided design/computer-assisted manufacture (CAD/CAM) technology after use of 1 of 3 scanning techniques, namely, direct scanning of the post space (DS), scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS). Thirty premolars were randomly assigned to three groups corresponding to the scanning technique. Posts were computer-designed and milled from experimental fiber-reinforced composite blocks. The mean (±SD) values for push-out strength and cement thickness were 17.1 ± 7.7 MPa and 162 ± 24 μm, respectively, for DS, 10.7 ± 4.6 MPa and 187 ± 50 μm for IS, and 12.0 ± 7.2 MPa and 258 ± 78 μm for MS specimens. Median (interquartile range) interfacial nanoleakage scores were 3 (2-4) for DS, 2.5 (2-4) for IS, and 3 (2-4) for MS. Post retention was better for fiber posts fabricated by DS technique than for those fabricated by IS and MS. Cement thickness did not differ between DS and IS specimens, but the cement layer was significantly thicker in the MS group than in the other two groups. Scanning technique did not affect sealing ability, as the three groups had comparable nanoleakage values.

Performance of CAD/CAM fabricated fiber posts in oval-shaped root canals: An in vitro study

PURPOSE

To assess the push-out strength, the cement layer thickness and the interfacial nanoleakage of prefabricated fiber posts, CAD/CAM fiber posts and metal cast posts cemented into oval-shaped root canals.

METHODS

Oval-shaped post spaces were prepared in 30 single-rooted premolars. Roots were randomly assigned to three groups (n=10), according to the post type to be inserted: Group 1: Prefabricated fiber post (D.T. Light-Post X-RO Illusion); Group 2: Cast metal post; Group 3: CAD/CAM-fabricated fiber post (experimental fiber blocks). In Group 3, post spaces were sprayed with scan powder (VITA), scanned with an inEos 4.2 scanner, and fiber posts were milled using an inLab MC XL CAD/CAM milling unit. All posts were cemented using Gradia Core dual-cure resin cement in combination with Gradia core self-etching bond (GC). After 24 hours, the specimens were sectioned perpendicular to the long axis into six 1 mm-thick sections, which were differentiated by the root level. Sections from six roots per group were used to measure the cement thickness and subsequently for the thin-slice push-out test, whereas the sections from the remaining four teeth were assigned to interfacial nanoleakage test. The cement thickness around the posts was measured in micrometers (µm) on the digital images acquired with a digital microscope using the Digimizer software. Thin-slice push-out test was conducted using a universal testing machine at the crosshead speed of 0.5 mm/minute and the bond strength was expressed in megaPascals (MPa). The interfacial nanoleakage was observed under light microscope and quantified by scoring the depth of silver nitrate penetration along the post-cement-dentin interfaces. The obtained results were statistically analyzed by Kruskal-Wallis ANOVA, followed by the Dunn's Multiple Range test for post hoc comparisons. The level of significance was set at P< 0.05.

RESULTS

Statistically significant differences were found among the groups in push-out bond strength, cement thickness and interfacial nanoleakage (P< 0.05). CAD/CAM-fabricated fiber posts achieved retention that was comparable to that of cast metal posts and significantly higher than that of prefabricated fiber posts. The cement layer thickness around CAD/CAM-fabricated fiber posts was significantly lower than around prefabricated fiber posts, but higher than that around cast metal posts. Root level was not a significant factor for push-out strength in any of the groups, whereas it significantly affected cement layer thickness only in the prefabricated fiber post group. No differences were observed in interfacial nanoleakage between CAD/CAM fabricated and prefabricated fiber posts, while nanoleakage recorded in cast metal posts was significantly lower.

CLINICAL SIGNIFICANCE

CAD/CAM fabricated fiber posts could represent a valid alternative to traditionally used posts in the restoration of endodontically-treated teeth with oval or wide root canals, offering the advantages of better esthetics, retention, and cement thickness values that are comparable to cast post and cores.

Effect of Reciproc endodontic treatment with three different post space preparation instruments on fiber post retention

PURPOSE

To assess the effect of three different drills used for post space preparation on fiber post retention after Reciproc endodontic treatment.

METHODS

30 human upper incisors were endodontically treated using Reciproc and warm vertical gutta-percha compaction. Teeth were sealed coronally using Fuji VII, then stored in 0.5% T chloramine solution at 4 degrees C. After 1 week, teeth were randomly assigned to three groups (n = 10) that differed for the drill type used for post space preparation: Group 1: Calibrated drill; Group 2: Largo drill; Group 3: MTwo drill. Illusion posts were luted into the root canals using Gradia Core. After 24 hours, posted roots were transversally cut into 1 mm-thick slices for thin-slice post push-out testing. Two slices per apical, middle, and coronal thirds were obtained, resulting in a total of 6 slices per tooth. Thin-slice push-out test was conducted using a universal testing machine. Post push-out strength was measured in MPa. For the fracture analysis, the specimens were observed using a stereomicroscope at x40 magnification and classified as adhesive [between post-cement (P-C) or dentin-cement (D-C) interface], cohesive (within the post or adhesive cement) and mixed (adhesive and cohesive fractures occurred simultaneously). Between-group differences in post retentive strength were statistically analyzed (Kruskal-Wallis ANOVA, Dunn's Multiple Range test, P > 0.05). Differences in push-out strength among root levels within each group (one-way ANOVA or Kruskal-Wallis ANOVA, depending on the normality of data distribution, P> 0.05) and in failure mode distribution were also statistically evaluated (Fisher's Exact Test, P > 0.05).

RESULTS

For each group the mean of MPa values was: (1) 10.41 ± 3.56, (2) 10.98 ± 3.96, and (3) 12.11 ± 1.65. Failure mode was distributed as follows: Adhesive: (1) P-C - 23.3%, D-C - 21.7%; (2) P-C - 20%, D-C - 10%; (3) PrC - 46.7%, D-C - 13.3%; Cohesive: (1) 0.0%, (2) 3.3%; (3) 0.0%; Mixed: (1) 55.0%; (2) 66.7%; (3) 40.0%. The statistical analysis revealed the existence of significant between-group differences (P= 0.002). Group 3 measured significantly higher push-out strengths than Groups 1 and 2, which were comparable. Statistically significant between-group differences emerged also in failure mode distribution (P= 0.004). In Group 3 post-cement adhesive failures were significantly more frequent and mixed failures were significantly less frequent than in Group 2. No statistically significant differences emerged among the different root levels of the tested groups (P > 0.05).

PSYCHOSOMATIC ASPECTS IN PATIENTS WITH DERMATOLOGIC DISEASES

The aim of our study was to find out the magnitude of anxiety and depression in our common dermatological patients and its correlation with age, sex. For this purpose, we used Hospital Anxiety and Depression Scale HADS. The psychometric validity of HADS has been established by validating the questionnaire against the structured psychiatric interviews. A study of anxiety and depression in patients with dermatologic diseases was conducted on the basis of outpatients department in 211 patients with dermatologic diseases; among them were 107 male and 104 female, aged 16 to 75 years. Among them were patients with Acne, Alopecia Areata, Psoriasis, Vitiligo, Neurodermatitis, Scabies, Eczema and Other diseases (Atopic Dermatitis, Chronic Urticaria, Lichen Planus, Herpes Zoster, Melasma, Warts and Etc.). Based on studies of patients reveals that 65.4% of them are anxiety, depression - 56.2%, both anxiety and depression in 24.7%, there figures higher than the dates of other authorizes. As a result of a direct link research risk disorder depressive spectrum with sex, age; in woman anxiety and depression occurs more frequently than men, and anxiety occurs more frequently in young age. Especially there are hight frequencies of manifestation of abuse in patients with Psoriasis (anxiety - 83.3%, depression - 69.4%, both - 38.8%), Eczema (anxiety - 73.3%, depression - 56.6%, both - 26.7%), Acne (anxiety - 78.4%, depression - 54%, both - 21.6%), Vitiligo (anxiety - 66.7%, depression - 60%, both - 33.3%). Our study noticed higher dates of anxiety and depression than the dates of other outhorizes.

Effect of repeated firings on flexural strength of veneered zirconia

OBJECTIVE

Chipping and/or delamination represent a clinical failure of porcelain fused to zirconia (PFZ) prostheses. Causes and solutions have not been completely clarified. The present study was aimed at evaluating the effects of number of firings on the flexural strength of PFZ specimen.

METHODS

Forty-five zirconia specimens in shape of bars were cut, sintered and divided in 3 groups (n=15). Group 1: veneering ceramic was layered "in bulk" and fired. Group 2: veneering ceramic was layered in three layers, individually fired. Group 3: veneering ceramic was layered in five layers, individually fired. Each layer thickness was controlled by the use of calibrated molds. The total veneering ceramic thickness for all the specimens was 1.2mm, and the total thickness of the specimen of 2.0mm. Three-point bending test was performed. Fracture load was recorded in Newton and MPa value was calculated taking into account the bi-layered nature of the specimen. Data were statistically analyzed.

RESULTS

Specimens obtained with on single firing cycle obtained a statistically significant (p<0.001) lower flexural strength (54.61±8.98MPa) than specimens veneered with 3 or 5 firing cycles. The last two obtained very similar results (77.63±13.17MPa and 73.62±12.38MPa respectively) and the differences was not statistically significant.

SIGNIFICANCE

In bi-layered PFZ specimen, three to five layers and firings determine higher flexural resistance when compared to a single firing. Thus, a 3-layers veneering procedure is recommended to increase flexural resistance. If a 5-layer procedure is necessary to improve esthetics, it does not decrease flexural resistance.

Influence of luting agent translucency on fiber post retention

The aim was to assess the influence of cement translucency on the retentive strength of luted fiber posts. Twenty extracted human premolars were randomly divided into four equal groups, based on the combinations of materials to be tested. Two post types of the same size, shape, and chemical composition, but different light-transmission properties [Translucent post (TP) and Opaque post (OP)] were selected. The two post types were luted using the etch-and-rinse, light-curing adhesive in combination with two shades of the same resin cement of markedly different light-transmitting ability [Transparent shade (TS) and Opaque shade (OS)]. Early post retention was assessed using the thin-slice push-out test. Post type did not significantly influence post retention; however, cement translucency emerged as a relevant factor in intraradicular cementation, with the TS achieving higher push-out strengths. The between-factor interaction was also statistically significant; specifically, OP-OS yielded significantly lower retentive strengths than all the other groups. Post translucency did not influence post retention, provided that a highly translucent cement was utilized for luting.

Periodontal status among adolescents in Georgia. A pathfinder study

Objectives. The aim of the present pathfinder study was to screen and map the periodontal status of Georgian population in accordance with the guidelines of the World Health Organization for population based surveys.

Methods. During 2012, a pathfinder study was conducted to collect this data. For the periodontal portion of the study, 15-year-old school children were examined in the capital city of Tbilisi as well as in two other large cities and 4 smaller villages. All participants were examined by a trained dental team in a classroom using a dental mirror and a periodontal probe. Periodontal examination included plaque scores, calculus scores, probing depth measurements and bleeding on probing. These measurements were recorded for the Ramfjord index teeth.

Results. A total of 397 15-year-old participants were examined in this pathfinder study. There were 240 females (60.45%) and 157 males (39.55%). Of the total participants 196 (49.37%) were urban adolescents while 201 (50.63%) were from rural communities. Mean probing depth was 3.34 ± 0.57 mm with a range of 1 to 10 mm; a relatively high proportion (34.26%) of these subjects presented with at least one site with pockets of 5 mm or deeper. Males presented with greater plaque, calculus and probing depths than females. When urban and rural populations were compared, urban participants presented with more plaque, probing depths and bleeding on probing. Greater pocket depths were found to be related to the presence of plaque calculus and bleeding on probing.

Conclusions. Overall, rather high incidences of periodontal pockets ≥ 5 mm were detected in this population. This data should serve to prepare further more detailed epidemiological studies that will serve to plan and implement prevent and treat strategies for periodontal diseases in Georgia and also help make manpower decisions.

Safety of patients--actual problem of modern medicine (review)

Safety of patients is actual problem of up-to-date medicine. The current successful treatment of various sicknesses is achieved by implementation in clinical practice such medical preparations (medications), which are characterized with the high therapeutic activity, low toxicity and prolonged effects. In spite of evidence of the pharmacotherapeutical advances, the frequency of complications after medication has grown - that is why the safety of patients is the acute actual problem of medicine and ecological state of human population today.